Basic cardiac auscultation is difficult to master and students should benefit from a teaching program which is infinitely patient and has a good range of abnormalities for the student to listen to. The program is based on one of a number used a t Thomas Jefferson University for their own medical students. It operates in two modes. The tutorial mode allows you to select one of 18 cardiac or circulatory conditions (e.g. mitral stenosis, carotid bruit, sinus tachycardia) and move your mouse over a pictorial representation of a ‘patient’ to hear the heart sounds over various areas of the chest. There is a pictogram of the cardiac cycle and any added sounds, and a brief list of key teaching points. The selftest mode reverses the process. You listen over the chest and choose the diagnosis from the list. The program covers major aortic and mitral murmurs, sinus rhythm, atrial fibrillation and rhythms with added S3 or S4 sounds and a few other abnormalities, all of which are relevant to the students. How does this simulation fare? I have to say that I found a number of major problems. The sounds are synthesized or electronically enhanced which often gives them an unrealistic metallic twang. On both 486 machines and a Pentium 90 the ‘tachycardia’ was well below 100 bpm and ‘normal S R was below 60 bpm. The localization of murmurs on the pictogram accords neither with the text comments nor the in viva situation. A few examples: aortic regurgitation is audible over the middle of the right clavicle; mitral stenosis is loudest near the left sternal edge (not at or just inside the apex) and is audible over the left biceps as are the sounds fiom mitral valve prolapse. The text relating to tricuspid regurgitation says it ‘never radiates to the axilla’, but listening over the pictogram it does (likewise with ventricular septa1 defect). Text comments are also at times inaccurate or confusing: aortic regurgitation is said to be associated with a ‘bounding’ pulse, the association is more with a ‘collapsing’ pulse. It is said that it may be associated with an Austin-Flint murmur but there is no explanation of what this is. Aortic sclerosis is said to be distinguished from mild aortic regurgitation by the presence of S2. The authors appear confused; the timing, location, pitch and pulse all help differentiate these two lesions, not the S 2 . The intensity of the S2 is diminished in aortic stenosis, not aortic incompetence, and may help to differentiate aortic stenosis from sclerosis. There were also some minor problems in attempting to load the program initially with overlapping introductory screens being generated (this occurred on some IBM compatible PCs but not all, and with two versions of the program). In summary, as there are betrer alcernatives available this product cannot be recommended due to its unnatural sound quality and the features noted above.